Under additional guidance that the CMS released Monday, a huge chunk of the uninsured won't have to pay the individual mandate penalty for 2018 because they live in a bare county or a region with just one exchange insurer and can claim new exemptions from the penalty for as far back as 2016.
This represents the most sweeping forgiveness of the individual mandate penalty to buy comprehensive coverage on the Affordable Care Act exchanges, extended a few weeks before the tax filing deadline.
The CMS guidance broadens what is known as a "hardship" exemption from the individual mandate to buy insurance. It extends the exemption to people who only have access to an insurance plan that covers abortion if they object to such coverage. Three states—California, Oregon and New York—require nearly all their insurance plans to cover abortion services, according to the National Women's Law Center. Those three states account for a big chunk of the Affordable Care Act enrollment numbers.
For 2018, California alone has more than 420,000 individual market enrollees, according to figures released by Covered California, the state's marketplace. New York has more than 250,000 enrollees in qualified health plans.
The individual mandate penalty has been zeroed out for 2019, but this policy would affect all those still subject to the penalty for 2018 if they don't buy a qualified health plan on the federally facilitated exchange or a state-based exchange whose exemptions are processed by the federal marketplace.
Those who live in a county with just one issuer can write a written explanation of why they are applying for the exemption if documentary evidence "is not readily available," according to the guidance.